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  ID Week
Oct 19, -23 2022
Washington DC

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High PrEP Awareness in US Women, But Only 20% Ever Used It
  IDWeek 2022, October 19-23, 2022, Washington, DC
Mark Mascolini
While 71% of US women participating in a national survey had heard of preexposure prophylaxis (PrEP) for HIV infection-including half who had heard of long-acting injectable (LA)-PrEP-only 20% ever used PrEP and only 9% used it at the time of the survey [1]. Interest in LA-PrEP remained high across study subgroups, but 42% of women mistakenly thought it could prevent other sexually transmitted infections (STIs).
Researchers from the University of North Carolina, ViiV Healthcare, and Evidera (a pharmaceutical research firm) undertook this ongoing survey to learn more about sexual health and behaviors, including PrEP use, in cisgender US women. They noted that women account for only about 8% of PrEP users in the United States [2]. The investigators aim to survey about 2000 women yearly for 3 years. This interim analysis involved 961 women surveyed in November and December 2021.
The research team recruited women via the social media platforms Facebook and Instagram and the dating app Tinder. Participants had to be 18 or older, a current US resident, and assigned female at birth and now identifying themselves as female. Women had to have penetrative anal and/or vaginal sex in the past 6 months. They had to be HIV negative or unaware of their HIV status.
Among the 961 women in this analysis, 47% lived in the West, 23% in the South, 16% in the Northeast, and 14% in the Midwest. Most women, 62%, were 18 to 29 years old, 30% were 30 to 39, and 8% were 40 or older. Proportions by race/ethnicity were 35% black/non-Hispanic, 20% black/Hispanic, 21% white/non-Hispanic, 12% white/Hispanic, and 12% another race/ethnicity. While 48% of respondents reported being single or dating, 47% said they were in a domestic partnership, civil union, or married, and 5% said they were widowed, separated, or divorced.
A small proportion of women, 16%, used a condom all the time, 36% most of the time, 32% some of the time, 11% a little of the time, and 5% never. More than half of respondents, 54%, ever got tested for HIV, although 56% rated their HIV risk as very unlikely, 29% as somewhat unlikely, 9% as somewhat likely, and 5% as very likely.
More than two thirds of respondents, 70.6%, had ever heard of PrEP, 37.8% had talked to a health care provider about PrEP, and 34.0% knew someone currently taking PrEP. PrEP awareness was highest, 93%, in the 40-to-49-year-old group, followed by 74% in the 18-to-29 group and 67% in the 30-to-39 group. As a racial/ethnic group, white Hispanics had the highest proportion aware of PrEP at 79%, followed by black non-Hispanics at 72%, white non-Hispanics at 67%, and black Hispanics at 63%.
Only 19.7% of women had ever taken PrEP, and only 9.3% currently used PrEP. PrEP use rates differed sharply by race/ethnicity: 49.2% of black Hispanic women ever used PrEP, compared with 14.6% of black non-Hispanics.
Half of these women, 50.1%, had heard of LA-PrEP, and the awareness rate was highest in 18-to-29-year-olds (55%), followed by the 30-to-39 group (43%) and the 40-to-49 group (41%). White Hispanics had the proportion with the highest awareness of LA-PrEP, at 72%, followed by black non-Hispanics and white non-Hispanics, both at 51%, and black Hispanics at 41%. While 31% of women thought they were very likely to use LA-PrEP, 35% called themselves somewhat likely, 15% somewhat unlikely, and 17% very unlikely. Reasons cited for interest in LA-PrEP were preventing HIV by 64.6%, preventing other STIs by 41.7% (a misconception), and ease of use by 34.5%.
While 62% of women voiced their preference for injected LA-PrEP over oral HIV PrEP, which 8.5% preferred; 29% preferred neither method. Among an array of HIV prevention measures, the most to least popular were condoms (47%), LA-PrEP given by a healthcare provider (24%), self-administered LA-PrEP (9%), a vaginal ring (9%), oral PrEP (7%), and none (2%).
Logistic regression analysis identified three independent predictors of willingness to use LA-PrEP: income up to $19,999 yearly (versus $100,000 yearly), knowing someone who currently uses PrEP, or current or prior use of oral PrEP. Independent predictors of unwillingness to use LA-PrEP were older age, fair/poor current mental health (versus excellent), and good current mental health (versus excellent).
The researchers affirmed the encouraging finding that some healthcare workers are talking to women about PrEP. But they noted the incorrect belief that LA-PrEP prevents non-HIV STIs points to a need for wider education about HIV prevention for US women. They cautioned that expressing interest in PrEP may not mean women will actually use it. And they suggested future surveys could ask about willingness to start PrEP in the immediate future.
1. Poteat T, Sarkar S, Ragone L, et al. Awareness and interest in PrEP options among US cisgender women-a national survey. IDWeek 2022, October 19-23, 2022, Washington, DC. Abstract 795.
2. Sullivan PS, Woodyatt C, Koski C, et al. A data visualization and dissemination resource to support HIV prevention and care at the local level: analysis and uses of the AIDSVu public data resource. J Med Internet Res. 2020;22:e23173. doi: 10.2196/23173. https://www.jmir.org/2020/10/e23173/